Employer
Leo Kob Co., Inc.
303 Jonlyn Dr, Elizabethtown, PA 17022 · EIN 23-2244008 · Jan 1, 2024 to Dec 31, 2024
Plan year 2024
Covered lives: 36
Schedule A
Direct compensation
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $6,745
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 27 | Comp not disclosed Premium $111,644 |
| Medical | Principal Life Insurance Company | — | — | Schedule A not provided |
| Vision | Capital Advantage Assurance Company | — | — | Schedule A not provided |
| Life | Unum Life Insurance Company Of America | Brown & Brown Insurance Services | 36 | $142 9.9% of $1,433 |
| Life | Unum Life Insurance Company Of America | Strategic Non-Medical Solution | 36 | $57 4.0% of $1,433 |
| Life | Boston Mutual Life Insurance Company | Brown & Brown Of Pennsylvania | 24 | $1,068 17.9% of $5,981 |
| Other | Madison National Life Insurance Company | — | — | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
| Supplemental | Colonial Life & Accident Insurance Company | — | 12 | Schedule A not provided |
Schedule C
Additional compensation
Plan-paid amounts to each named party on the filing, with the role they reported. This is not a carrier commission and is not added to Schedule A.
Visible subtotal $30,117
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Brown & Brown (Pa) | Broker | $12,402 | $344.50 |
| The Benecon Group | Broker | $7,947 | $220.75 |
| Capital Bluecross | Admin | $8,032 | $223.11 |
| ConnectCare3 | Patient Advocate | $1,736 | $48.22 |